Breast cancer is the leading cause of cancer in Pacific Islander women with rates increasing disproportionately as compared to other communities (1, 2). Anecdotal information from communities suggests that such women also delay care because of intense fear and shame of their condition. Furthermore, Pacific Islander women diagnosed with breast cancer who do seek care generally select more radical treatment options, such as mastectomy, due to fear of recurrence.3 One consequence of such breast cancer treatment is impairment of the lymphatic system, leading to lymphedema or the accumulation of lymphatic fluid in the tissues that causes swelling, usually in the arms of breast cancer survivors. Although LE occurs in up to half of all breast cancer survivors, resulting in significant physical as well as psychological impacts, little is known about the LE occurrence and impacts in ethnic minority women. This study proposes to explore the factors affecting LE knowledge, early detection, and care management in Pacific Islander breast cancer survivors - namely, Chamorros (indigenous Guamanians) and Samoans. Such an understanding is crucial to developing models of education and detection in not only these medically underserved populations, but others where cultural taboos combined with medical inaccessibility leave women underserved and in the dark about the risks for, and management of, lymphedema. ? ? The aims of this current proposal are within the scope of the parent Community Networks Program (CNP), Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART). First, we will work closely with leaders and members of the Chamorro and Samoan communities in Southern California in the development of the interview guides for the study. The Project Leader of the present proposal is herself a Guamanian/Chamorro MD/MPH, and has strong established relationships with the proposed community organization partners in this study. Such organizations will also assist with the crucial task of identifying and recruiting breast cancer survivors from each community, thereby using their own social networks to approach women who may be feeling fear and shame from their cancer conditions. The findings from this study can also be used to develop a culturally-tailored, provider and community mediated educational intervention to promote early LE diagnosis and management. In order to develop an efficacious and sustainable intervention, attitudes and beliefs related to breast cancer and LE must be understood through this pilot project. Working closely with the Chamorro and Samoan community members, we will conduct such a pilot study to assess the LE risk, diagnosis and management knowledge and attitudes among survivors in Orange and Los Angeles counties. ? ? The goal of this study is to assess knowledge, attitudes and behaviors regarding lymphedema (LE) risk and early detection/management among Pacific Islander breast cancer survivors in Los Angeles, Orange and San Diego counties of Southern California. Due to the exploratory nature of this study, we propose the following specific aims: 1) To develop a qualitative focus group discussion guide that explores cultural and psychosocial factors specific to knowledge and attitudes of LE risk, early detection and management, 2) To recruit a total of 40 Chamorro and Samoan breast cancer survivors to participate in focus group discussions about their LE knowledge and attitudes, as well as how LE influenced their treatment decisions, and 3) To develop a model peer-education program to increase LE knowledge and positive attitudes towards early detection and management that can be tested in a future study. ? ? ? ?
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